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Wednesday, July 11, 2012

Medical Definitions and Practices

Heart Transplant Procedure

How much of our communal lives is devoted to discussions of Medicine? A good deal is; we discuss issues from Health Care and Health Insurance on the basis of economics to Abortion on the basis of morality and philosophy and religious belief.
In short, Medicine is discussed under almost all the categories which make societies work: Economics, Business, Morality, Ethics, Religion, Philosophy, Politics...

I suggest that Medical Practice may substitute for Life: in essence, let us run a simulation of Life by looking at medical practices and our discussions and involvement in them.

The article cited above deals with organ donations, and how those affairs are defined and run. Read it and pay attention to how the important terms are defined. In particular, we are interested here in how "death" is defined, because we are dealing with organ donations from individuals who are declared to be dead.

I quote the beginning paragraphs below:

In 1968, thirteen men gathered at the Harvard Medical School to
virtually undo 5,000 years of the study of death. In a three-month
period, the Harvard committee (full name: the Ad Hoc Committee of the
Harvard Medical School to Examine the Definition of Brain Death)
hammered out a simple set of criteria that today allows doctors to
declare a person dead in less time than it takes to get a decent eye
exam. A good deal of medical language was used, but in the end the
committee’s criteria switched the debate from biology to philosophy.
Before many years went by, it became accepted by most of the medical
establishment that death wasn’t defined by a heart that could not be
restarted, or lungs that could not breathe. No, you were considered dead
when you suffered a loss of personhood.

But before we see what substituting philosophy for science actually
means to real patients, let’s look at the criteria the Harvard authors
believed indicated that a patient had a “permanently nonfunctioning
brain”:

• Unreceptivity and unresponsivity. “Even the most intensely painful
stimuli evoke no vocal or other response, not even a groan, withdrawal
of a limb or quickening of respiration,” by the committee’s standard.

• No movements or spontaneous breathing (being aided by a
respirator does not count). Doctors must watch patients for at least one
hour to make sure they make no spontaneous muscular movements or
spontaneous respiration. To test the latter, physicians are to turn off
the respirator for three minutes to see if the patient attempts to
breathe on his own (the apnea test).

• No reflexes. To look for reflexes, doctors are to shine a light in
the eyes to make sure the pupils are dilated. Muscles are tested. Ice
water is poured in the ears.

• Flat EEG.
Doctors should use electroencephalography, a test “of great
confirmatory value,” to make sure that the patient has flat brain waves.

The committee said all of the above tests had to be repeated at least 24 hours later with no change, but it added two caveats: hypothermia and drug intoxication can mimic brain death. And since 1968, the list of mimicking conditions has grown longer.

Despite heroic efforts to clarify and justify the definition of death, it remains opaque, confusing, and inconsistent.

Although the Harvard criteria were based on zero patients and no
experiments were conducted either with humans or animals, they soon
became the standard for declaring people dead in several states, and in
1981, the Uniform Determination of Death Act (UDDA) was sanctioned by the National Conference of Commissioners on Uniform State Laws.
The UDDA is based on the Harvard Ad Hoc Committee’s report. That a
four-page article defining death should be codified by all 50 states
within 13 years is staggering.

To me, the point of all this exercise is to wake me from my slumber induced by the anesthesia of Authority, and see what is actually going on: and what is going on is an imperfect process which - even though we tend to impute great validity to it because it is a product of great Authority - remains imperfect and may become more so.

We are all imperfect.

Who, then, is qualified to pass perfect judgement upon other weighty questions, such as when does Life begin, and Abortion?
Not I.
I am not qualified, yet I must decide... and that is a strange thing, is it not?
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PS.
Another facet of organ donation is that are various agents and agencies involved, some of which are paid for organs located and used.
The only party which is absolutely prohibited from receiving money is the donor or their family; everyone else may make some money on the deal.
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